Rhinitis and pregnancy: literature review

Caparroz, Fábio Azevedo; Gregorio, Luciano Lobato; Bongiovanni, Giuliano; Izu, Suemy Cioffi; Kosugi, Eduardo Macoto

doi:10.1016/j.bjorl.2015.04.011

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Brazilian Journal of Otorhinolaryngology

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REVIEW ARTICLE • Braz. j. otorhinolaryngol. 82 (1) • Jan-Fev 2016 • https://doi.org/10.1016/j.bjorl.2015.04.011 copy

Rhinitis and pregnancy: literature review ^{^☆} ☆ Please cite this article as: Caparroz FA, Gregorio LL, Bongiovanni G, Izu SC, Kosugi EM. Rhinitis and pregnancy: literature review. Braz J Otorhinolaryngol. 2016;82:105-11.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

INTRODUCTION:

There is a controversy concerning the terminology and definition of rhinitis in pregnancy. Gestational rhinitis is a relatively common condition, which has drawn increasing interest in recent years due to a possible association with maternal obstructive sleep apnea syndrome (OSAS) and unfavorable fetal outcomes.

OBJECTIVE:

To review the current knowledge on gestacional rhinitis, and to assess its evidence.

METHODS:

Structured literature search.

RESULTS:

Gestational rhinitis and rhinitis "during pregnancy" are somewhat similar conditions regarding their physiopathology and treatment, but differ regarding definition and prognosis. Hormonal changes have a presumed etiological role, but knowledge about the physiopathology of gestational rhinitis is still lacking. Management of rhinitis during pregnancy focuses on the minimal intervention required for symptom relief.

CONCLUSION:

As it has a great impact on maternal quality of life, both the otorhinolaryngologist and the obstetrician must be careful concerning the early diagnosis and treatment of gestational rhinitis, considering the safety of treatment measures and drugs and their current level of evidence.

Keywords:
Rhinitis; Pregnancy; Nasal obstruction

Type of article	Number of articles	References
Subject review	5	1, 7, 11, 20 and 41
Diagnostic	2	9 and 28
Historical articles	3	3, 4 and 5
Prevalence and incidence only	1	10
Physiopathology and physiopathogeny	10	8, 12, 13, 14, 15, 16, 17, 18, 19 and 26
Treatment	5	6, 24, 27, 35 and 38
Outcome and associated conditions	15	2, 21, 22, 23, 25, 29, 30, 31, 32, 33, 34, 36, 37, 39 and 40

Measure	Benefit
Educational	Adjuvant, clarification of doubts, and reduced chance of using harmful substances^{7, 24 and 25}
Physical exercise	Nasal obstruction improvement²⁶
Nasal irrigation with saline solution	Temporary symptom relief⁷

Risk	Evidence
Risk A	There is no evidence of risk in pregnant women.
Risk A	Well-controlled studies have showed no problems in the first trimester of pregnancy and there is no evidence of problems in the second and third trimesters.

Risk B	There are no adequate studies in pregnant women.
Risk B	Animal experiments have detected no risks.

Risk C	There are no adequate studies in pregnant women.
Risk C	There were some side effects on the fetus in animal experiments, but the product benefit may justify the potential risk during pregnancy.

Risk D	There is evidence of risk in human fetuses.
Risk D	Only to be used if the benefit outweighs the potential risk: life-threatening situations, or in cases of severe diseases for which safer drugs cannot be used, or if these drugs are ineffective.

Risk X	Studies have disclosed abnormalities in the fetus or evidence of risk to the fetus.
Risk X	The risks during pregnancy outweigh the potential benefits. Should not be used during pregnancy under any circumstances.

FDA classification	Drug class	Indication	Name of substance	Detailed information
A and B
	Oral anti-histaminics	AR	Cetirizine	Proven safety in animals and humans.⁴⁰
			Chlorpheniramine
			Loratadine
	Intranasal corticosteroid	AR	Budesonide	Safely used in asthmatic pregnant women.³⁵ Not recommended in GR.

C
	Oral anti-histaminics	AR	Azelastine
			Fexofenadine
	Intranasal corticosteroid	AR	Fluticasone	Not recommended in GR.²⁴ When considering the risk/benefit in AR, its use can be maintained if the pregnant woman was using before pregnancy with good results.³⁸
			Triamcinolone
			Mometasone
	Systemic decongestant	AR and GR	Pseudoephedrine	Possible risk of gastroschisis in the fetus (first quarter). Maternal tachycardia, anxiety, tremors, and insomnia.^{7 and 28}
			Phenylpropanolamine
	Topical decongestant	RA and RG	Phenylephrine	Association with congenital malformations, especially in the first trimester.^{28 and 33} Limited evidence suggests safety for one or a few doses of oxymetazoline after the first trimester.²⁷
			Naphazoline
			Oxymetazoline
			Xylometazoline

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail:fcaparroz@hotmail.com (F.A. Caparroz).

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Rhinitis and pregnancy: literature review ☆ ☆ Please cite this article as: Caparroz FA, Gregorio LL, Bongiovanni G, Izu SC, Kosugi EM. Rhinitis and pregnancy: literature review. Braz J Otorhinolaryngol. 2016;82:105-11.

ABSTRACT

INTRODUCTION:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Rhinitis and pregnancy: literature review ^{^☆} ☆ Please cite this article as: Caparroz FA, Gregorio LL, Bongiovanni G, Izu SC, Kosugi EM. Rhinitis and pregnancy: literature review. Braz J Otorhinolaryngol. 2016;82:105-11.